'I don't do like I used to do': A grounded theory approach to conceptualising awareness in people with moderate to severe dementia living in long-term care
'I don't do like I used to do': A grounded theory approach to conceptualising awareness in people with moderate to severe dementia living in long-term care
复制标题
DOI：
10.1016/j.socscimed.2008.01.045
复制
发表时间：
2008-06-01
影响因子：
5.4
通讯作者：
Downs, Murna
中科院分区：
文献类型：
--
作者：
Clare, Linda;Rowlands, Julia;Downs, Murna
虽然居住在社区中的轻度至中度痴呆症患者的意识已经得到了广泛的研究，但很少有证据表明居住在寄宿护理中的中度至重度痴呆症患者对自己的情况和功能的认识程度。本研究旨在探讨不同程度的意识是如何表现在居民护理环境中的痴呆症患者的对话和互动，并确定理论和实践意义。使用扎根理论的方法分析了304个谈话的成绩单与80个痴呆症患者住在养老院在英格兰和威尔士。所有80名参与者都表现出一定程度的保留意识，并且在整个对话中有相当多的证据表明保留意识，表现在自我，关系和环境背景这三个领域。三分之二的参与者还表现出至少一个不知情的情况下，虽然保留的意识的示威超过不知情的迹象。在评估运作情况和赋予这种情况的意义方面，显然缺乏意识。中重度痴呆症患者的意识的扎根理论模型仍然口头交流，提出意识的展示涉及一组分析和行为过程，范围或时间尺度和焦点。通过涉及不同复杂程度的认知过程，从登记到评价和解释，再到反思，就特定的重点和范围而言，认识得到了体现。无意识可能表现为与过程、重点或范围的某些要素有关，而其他方面则不受影响。更多地了解保留意识的能力以及意识可能受到损害的具体方式，可能有助于护理人员有效地应对居民的需求。(C)2008爱思唯尔有限公司保留所有权利。
While awareness among people with mild to moderate dementia residing in the community has been extensively studied, little evidence has been presented regarding the extent to which people with moderate to severe dementia living in residential care show awareness of their own situation and functioning. The present study aimed to explore how differing degrees of awareness are manifested in the conversations and interactions of people with dementia living in residential care settings, and to identify theoretical and practical implications. Transcripts of 304 conversations with 80 individuals with dementia living in residential care homes in England and Wales were analysed using a grounded theory approach. All 80 participants demonstrated a degree of retained awareness, and there was considerable evidence of retained awareness throughout the conversations, expressed in relation to the three domains of self, relationship, and the environmental context. Two-thirds of participants also demonstrated at least one instance of unawareness, although demonstrations of retained awareness outweighed indications of unawareness. Unawareness was evident in relation to appraisal of functioning and the meaning ascribed to the situation. A grounded theory model of awareness in people with moderate to severe dementia who still communicate verbally proposes that demonstration of awareness involves a set of analytic and behavioural processes, a scope or timescale, and a focus. Awareness is demonstrated in relation to a given focus and scope through the involvement of cognitive processes of varying degrees of complexity, ranging from registering through appraising and interpreting to reflection. Unawareness may be demonstrated in relation to some elements of process, focus or scope, while other aspects remain unaffected. Understanding more about the capacity for retained awareness and the specific ways in which awareness can be compromised may assist care staff in responding effectively to residents' needs. (C) 2008 Elsevier Ltd. All rights reserved.